COMPANION MEETING: SOCIETY FOR ULTRASTRUCTURAL PATHOLOGY. UNITED STATES CANADIAN (USCAP) ACADEMY OF PATHOLOGY, 2017. LOOK-ALIKES IN SPINDLE AND EPITHELIOID TUMORS

Abstract:

Due to the variable light microscopic appearance and overlapping morphologic patterns of spindle cell/epithelioid tumors, there are a large number of neoplasms that may need to be considered in the differential diagnosis depending on the particular situation. In a number of difficult cases, the surgical pathologist must approach the differential diagnosis using ancillary diagnostic techniques and should do so in a proper, efficient fashion, recognizing that arriving to the correct diagnosis is without doubts the most important goal. It is also imperative to take into account the expense and time that may be involved in arriving to the definitive diagnosis. Therefore, the most reasonable route to address the differential diagnosis and to make a final unequivocal interpretation should be taken. Whether immunohistochemistry, electron microscopy, cytogenetics and/or molecular diagnostics should be employed in the case in question becomes the dilemma. In some cases a combination of the above mentioned techniques is important not only to solidify the diagnosis but also to provide important additional information regarding prognosis, treatment and other important factors. Differentiation of sarcomas from sarcomatoid carcinomas, spindle and pseudo sarcomatous reactions can create challenging diagnostic dilemmas. Differentiation of these entities by light microscopy alone can be almost impossible in some cases. Keratin expression by immunohistochemistry is quite variable in poorly differentiated carcinomas in general, where the entity of sarcomatoid carcinoma usually falls. While keratin staining using a variety of cocktails may be of value, it is not …

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